Healthcare Provider Details

I. General information

NPI: 1366943813
Provider Name (Legal Business Name): BROOKE MOKONYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 02/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 N MEDALIST CIR
PLANO TX
75023-2831
US

IV. Provider business mailing address

913 N MEDALIST CIR
PLANO TX
75023-2831
US

V. Phone/Fax

Practice location:
  • Phone: 214-462-5104
  • Fax:
Mailing address:
  • Phone: 214-462-5104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number892822
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: